OPEN Research Support

Professor and consultant
Frantz Rom Poulsen
Department of Neurosurgery, Odense University Hospital

Projekt styring
Projekt status    Planning
Data indsamlingsdatoer
Start 01.12.2017  
Slut 31.12.2018  

A comparison between extent of resection of high grade gliomas using peroperative 5-ALA or Fluore-scein

Short summary

Surgery is one of the key treatments of brain cancer (malignant glioma). To visualize the malignant tissue during surgery, one of two fluorescent substances can be used: 5-ALA (aminolevulinic acid) or Fluorescein. Although both visualize tumor tissue when illuminated by fluorescent light, the mechanism of action is very different. This study investigates if type of fluorescense affect the extent of resection between 5-ALA and Fluorescein based on the early postoperative MRI scan and the possible difference in time to progression and overall survival between the two groups. 



Even though that 5-ALA and Fluorescein both are used as peroperative tumor-marking, their mechanisms of action are different. Where  5-ALA is a marker of tumor cells, Fluorescein is a marker of degraded blood-brain barrier. After tumor resection 5-ALA leaves a vague redish color as border between healthy tissue and contrast-enhancing cancer-tissue that can be hard to define. Fluorescein gives a greenish color with a more sharp distinction between contrast and non-contrast enhancing tissue. In addition, fluorescein is significantly cheaper than 5-ALA. Despite the difference between healthy tissue and cancer-tissue seems more clear with Fluorescein, the radicality of resection guided by either of these two substances is not yet clear. This study aimes to investigate this issue in two ways: the difference between the extent of resection measured on early postoperative MRI-scans and the possible difference progression free and overall survival in these two groups. Previous studies have shown a correlation between the radicality of the removal of malignant tissue and the prognosis.


Description of the cohort

The cohort consists of approximately 150 patients, who has undergone surgery for malignant glioma on the department of neurosurgery, Odense University Hospital, using either 5-ALA or Fluorescein. The study is retrospective, including data on patients from 2012 to 2017. The cohort is divided by type of fluorescens, and matched for demografic variables and key paramters/comorbidities that could influence mortality.


Data and biological material

Data will be extracted from the electronic health data record linked to the civil registration number. Criteria of inclusion is action code (C71.X) on patient from the above mentioned time period. The extent of resection will be measured on a postoperative MRI-scan and compared to the pre-operative scan used for the MRI-navigation during the operation.